title: A comparison of outcome for stroke patients in Barbados and South London.
abstract: OBJECTIVE
  Little is known about the poststroke outcome in Caribbean populations. We investigated differences in the activities of daily living, level of social activities, living circumstances and survival for stroke patients in Barbados and London.
  
  
  METHODS
  Data were collected from the South London Stroke Register and the Barbados Register of Strokes for patients with a first-ever stroke registered between January 2001 and December 2004. The ability to perform activities of daily living was measured by the Barthel Index and level of social activities by the Frenchay Activities Index. Living circumstances were categorised into private household vs. institutional care. Death and dependency, activities of daily living and social activities were assessed at three-months, one- and two-years using logistic regression, adjusted for differences in demographic, socioeconomic and stroke severity characteristics.
  
  
  RESULTS
  At three-months, a high level of social activities was more likely for the Barbados Register of Strokes (odds ratio 1.84; 95% confidence interval 1.03-3.29); there were no differences in activities of daily living; and Barbados Register of Strokes patients were less likely to be in institutional care (relative risk ratio 0.38; 95% confidence interval 0.18-0.79). Following adjustment, Barbados Register of Strokes patients had a higher risk of mortality at three-months (relative risk ratio 1.85; 95% confidence interval 1.03-3.30), one-year (relative risk ratio 1.83; 95% confidence interval 1.08-3.09) and two-years (relative risk ratio 1.82; 95% confidence interval 1.08-3.07). This difference was due to early poststroke deaths; for patients alive at four-weeks poststroke, survival thereafter was similar in both settings.
  
  
  CONCLUSIONS
  In Barbados, there was evidence for a healthy survivor effect, and short-term social activity was greater than that in the South London Stroke Register.
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK. nigel.smeeton@kcl.ac.uk
authors.forename: Nigel C
authors.initials: NC
authors.lastname: Smeeton
authors.forename: David O C
authors.initials: DO
authors.lastname: Corbin
authors.forename: Anselm J M
authors.initials: AJ
authors.lastname: Hennis
authors.forename: Ian R
authors.initials: IR
authors.lastname: Hambleton
authors.forename: Angela M C
authors.initials: AM
authors.lastname: Rose
authors.forename: Henry S
authors.initials: HS
authors.lastname: Fraser
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001460:Barbados / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries; D012959:Socioeconomic Factors; D020521:Stroke / Q000401:mortality*